Policy Terms & Conditions

Specific Stop Loss

Available as stand alone or together with Aggregate Stop Loss Coverage

Deductible Choices:$15,000 to $300,000+
Percentage Reimbursement:Standard 100%, rate discounts for coinsurance
Maximum Reimbursement:Unlimited per person
Basis Of Coverage:– Incurred and paid during policy period (12/12)

– Incurred within the policy period and paid within 90 days (12/15)

– Paid within the policy period with dollar or day run-in limit (only if employer is currently self-funded)
Specific Cash Advance:Waives the requirement that claims in excess of the specific deductible be paid before a request for reimbursement is submitted. This feature will be applied at the insurance carrier’s discretion and only if the Policyholder has complied with the terms and conditions of the Policy.

Aggregate Stop Loss

Available only in conjunction with Specific Stop Loss Insurance

Minimum Attachment Point:125% of expected claims
Percentage Reimbursement:Standard 100%, rate discounts for coinsurance
Maximum Reimbursement:$1 million per policy period (option up to $2 million)
Basis Of Coverage:– Incurred and paid within the policy period (12/12)

– Incurred within the policy period and paid within 90 days (12/15)

– Paid within the policy period with dollar or day run-in limit (only if employer is currently self-funded)
Advance Aggregate Funding:
(Optional Coverage)
This option helps to protect the employer’s cash flow in the event that claims exceed the minimum accumulated monthly aggregate. The employer can receive reimbursement prior to the end of the policy period.
Terminal Liability:
(Optional Coverage)
This option provides run-out protection for 90 days immediately after the end of the policy period. The revised Annual Aggregate Deductible becomes the sum of the monthly aggregate deductibles for the three months prior to the last date of the policy period plus the annual attachment point for the policy period.  This option can only be exercised if the policy holder’s self-funded plan is terminated.